Central New York is a great place to live, work and recreate. We have thriving downtown communities, scenic landscapes, world-class universities and hospitals and incredible outdoor opportunities in our collective backyard. We have something for everyone, and our healthcare system is no exception. Syracuse is home to Upstate University Hospital, New York's only Level I trauma care center for adults and pediatrics, Crouse Hospital, Syracuse VA Medical Center, and St. Joseph's Hospital Health Center. As such we are central in more than geography; individuals from 14-plus counties depend on us for life-saving healthcare.

As we all know, access is critically important in healthcare. The best trauma and emergency departments in the world cannot save someone who can't get there in time. Many people who call Onondaga County and Central New York home live in rural communities and when they experience traumatic accident, heart attack, stroke or other emergent conditions, they need to get to one of Syracuse's medical centers quickly because local facilities may not be equipped to treat them.

Our regional neighbors are not alone in living a considerable distancefrom life-saving healthcare centers. Eighty-five million Americans live more than an hour from a Level I or Level II trauma center by ground transport, and that number will only grow. Since 1990, more than 22 percent of America's hospitals have closed. According to the Center for Rural Affairs, rural hospitals have been closing at a rate of nearly one per month since 2010. Air medical transportation has emerged as a crucial link for these individuals who have no option for appropriate emergency care without air transport.

Rural residents aren't the only ones who depend on air ambulances in an emergency. First responders have to make the best possible decision in the moment and lives depend on the right medical services being available and dispatched quickly, regardless of where the medical event occurs. Unfortunately, the system that reimburses air medical providers is broken.

Most emergency transport providers are being squeezed by drastically low government reimbursement rates and insurers reluctant to negotiate fair rates. It is not unusual for seven of every 10 air medical transports to be substantially under-reimbursed. This system unfairly shifts the cost from under-reimbursed transports to other patients. If the current system is not fixed, then lives will ultimately be lost because these providers may have to curtail or cut service. While many people in Onondaga County have access to appropriate care through ground transport, the loss of emergency air service will affect our trauma and emergency centers, and many of our friends and relatives.

Thankfully there are efforts at the federal level to update the Medicare reimbursement rates for air ambulance transports. The Onondaga County Legislature recently voted to support the work of the Save Our Air Medical Resources (SOAR) Coalition to address this issue.

As county legislators representing the city of Syracuse and the rural stretches of the county, we must ensure continued access to this critical lifeline. Federal legislation that modernizes Medicare reimbursement rates for emergency air medical transport will help make that happen. New York state can also help by continuing to provide supplemental payments for ground service providers while advocating for increased Medicaid reimbursements. And lastly, insurers and air medical transport providers must work in good faith to forge fair, in-network agreements.

We love living in Central New York and we are incredibly proud of our healthcare institutions. We deserve to know that if trauma strikes, resources are available to care for everyone who needs it.

David H. Knapp represents the 12th District in the Onondaga County Legislature. He chairs the Ways and Means Committee. Christopher J. Ryan represents the 8th District in the county legislature. He is vice-chair of Planning and Economic Development.